Survival After Heart Transplant is Poor with High Venous Pressures and Low Arterial Elastance

Abstract

<h3>Purpose</h3> High venous pressure is a risk factor for renal dysfunction and mortality in decompensated heart failure. Medical management involves lowering arterial elastance (Ea) with vasodilators. We hypothesized that high venous pressures and a low Ea may have a poor prognosis after heart transplantation due to impaired organ perfusion. <h3>Methods</h3> We retrospectively studied the effect of high venous pressures more than 15 mm hg on survival of 250 isolated heart transplants. Arterial elastance was calculated as E_sys / SV End systolic pressure E_sys = (2* systolic blood pressure + diastolic pressure) / 3 Organ perfusion pressure index (OPPI) was calculated as (Mean arterial pressure- RAP) / BSA <h3>Results</h3> Higher RAP was a significant risk factor for 90 day mortality (p = 0.007) . This risk decreased with increasing Ea (p = 0.000). Lower OPPI (p ∼0.000) had a significant effect on 90 day mortality. The impact of high RAP and low arterial elastance persisted at medium term follow up. Kaplan Meier estimates for survival at 5 years was significantly worse if RAP was more than 15 mm hg (p ∼ 0.0059) This effect of RAP on 5 year survival was absent if Ea was > 2.7.Survival at 5 years was significantly worse if OPPI was < 40. (p ∼ 0.0124).This effect was absent if RAP was < 15 mm hg. <h3>Conclusion</h3> Elevated venous pressure> 15 mm hg with low Ea has poor outcomes of transplantation . The effect seems to be mediated through a decrease in OPPI. A value of OPPI less than 40 mm hg is associated with poor outcomes.